September 3, 2015
Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. About 2,350 men are diagnosed with the disease each year. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.
Most men diagnosed with breast cancer have mastectomy to remove the cancer. Men don't usually have lumpectomies because their breasts are so small. By the time the tumor and the tissue around it have been removed, very little breast tissue is left.
Studies have found that more women diagnosed with breast cancer in one breast are opting to have that breast and the other healthy breast removed -- a double mastectomy. Removing the other healthy breast is called contralateral preventive mastectomy. The healthy breast usually is removed because of an understandable fear that a new, second breast cancer might develop in that breast. Rates of contralateral preventive mastectomy in women have gone from about 2.2% in 1998 to 11% in 2011.
Researchers wondered if the same increase in contralateral preventive mastectomy was happening in men diagnosed with breast cancer.
A study has found that it has. Rates of contralateral preventive mastectomy in men nearly doubled between 2004 and 2011.
The study was published online on Sept. 2, 2015 by JAMA Surgery. Read the abstract of "Temporal Trends in and Factors Associated With Contralateral Prophylactic Mastectomy Among US Men With Breast Cancer."
To figure how many men were having contralateral preventive mastectomy, researchers from the American Cancer Society looked at treatment information in the North American Association of Central Cancer Registries.
A total of 6,332 men were diagnosed with breast cancer and had surgery from 2004 to 2011:
• more than 50% of the men were 60 or older when diagnosed
• more than 80% were white, 12% were black, and 5% were Hispanic
In 2004, about 3% of the men had contralateral preventive mastectomy. In 2011, 5.6% of the men did. This is a relative increase of 86.7%.
Men who were younger, white, and who had private insurance were more likely to have contralateral preventive mastectomy. These same factors were linked to being more likely to have contralateral preventive mastectomy in women.
Still, having genetic testing, family history, MRI testing, and fear of developing breast cancer in the other breast are all also linked to being more likely to have contralateral preventive mastectomy in women. In this study, the researchers didn't have information to determine if these factors were also linked to being more likely to have contralateral preventive mastectomy in men.
The researchers pointed out that for both men and women, there is no evidence that contralateral preventive mastectomy improves survival. It's important to know that double mastectomy is a bigger operation than single mastectomy and is associated with a more difficult recovery and more complications.
"The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care," said Ahmedin Jemal, D.V.M., Ph.D., vice president of surveillance and health services research at the American Cancer Society. "Health care providers should be aware that the increase we've seen in removal of the unaffected breast is not limited to women, and doctors should carefully discuss with their male patients the benefits, harms, and costs of this surgery to help patients make informed decisions about their treatments."
If you are a man or woman who's been diagnosed with early-stage breast cancer in one breast, ask your doctor about ALL of your treatment and risk reduction options. Double mastectomy is only one of these options and is an aggressive step. While that may be the right decision for you, give yourself the time you need to consider your decision carefully. Talk to your doctor to make sure that your decisions are based on your actual risk. Ask your doctor about how the cancer details in your pathology report may affect your future risk. Together, you and your doctor can make the decisions that are best for you and your unique situation.